Strong Medicine

October 25th, 2010 by gelenberg Leave a reply »

From time to time, a patient or family member asks about a treatment I have recommended and am about to prescribe, “Doctor, is this a strong medicine?” Sometimes the person talks about a previous doctor who just prescribed something “mild” for perhaps minor symptoms.

I’ve been a doctor for so long that such questions often take me aback. They are phrased in a foreign tongue. I think in terms of potency, efficacy, and safety. I weigh numbers needed to treat and harm, risks versus benefits. Scientific stuff.

Naïve questions prompt me to re-engage my empathy, to metaphorically put myself in the consumer’s seat. Occasionally I recommend something mild: mint tea for a little nausea, or walking for tension or easy exercise. They are pretty safe and unlikely to cause discomfort. But most of our treatments are in fact powerful. They can cause harm. It’s important to ask what a patient or family member means when a phrase is ambiguous. (“What do you mean by ‘strong?’”) But often the meaning is simply, “Will it hurt or harm?” And that’s a good place to start the process of building a partnership for treatment.

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